COLUMN: Increasing concern about the cost and quality of home care, say Sheffield health chiefs

Stephanie Bateman

Care at home really makes a difference to people - it’s often the difference between staying in your own home and being in residential care.

Healthwatch Sheffield is hearing increasingly from people concerned about the availability, cost and quality of care at home. As the local consumer watchdog for health and social care, we are investigating the situation and gathering people’s views on home care. We aim to identify what really matters to people so that providers can focus their work most effectively. If you or someone you know receives care at home, please complete our survey to help us build up a picture of what is happening (see below for details).

Care provided in people’s homes is used by approximately 900,000 people in the UK. It includes help with getting in and out of bed, washing, preparing meals, shopping, cleaning and support taking medication. Home care often allows people to remain living at home and independent, rather than having to stay in hospital or move to residential care. While 80 per cent of those receiving care at home are 65 or over many disabled people also rely on this.

Demand for this service continues to rise as the population ages, yet funding to councils for social care has not kept pace with these increasing needs and the costs of providing care. Depending on a person’s financial situation and their need as assessed by a social worker, home care is paid for in different ways. For some, the Council pays all or part of the costs, some people may have to fund their own care, while others rely on family or friends - or go without.

Lucy Davies, advocacy manager at Disability Sheffield Centre for Independent Living said: “People tell us how important home care is to support them to live their lives independently. They often tell us how great some of their individual carers are, and how hard they work.

“However, recent changes to the way care is delivered, mean that increasingly we hear from people frustrated by the lack of choice of providers, and the quality of the services on offer. One commonly raised issue is the hourly rate offered by the Council which only allows people to access the very cheapest agencies, unless they top up the payments themselves, and this simply doesn’t get them the quality of care they need.

“They also tell us that things could be improved by allowing people greater flexibility over how they use the ‘pot’ of care that is allocated to them; at the moment the plans worked out by social workers are often inflexible, and rigidly determine the timeslots of care, and what is delivered within them.“

In its 2016 report on social care, Sheffield City Council reported that 1 in 20 of Sheffield’s population had requested support from the council and that requests had increased seven per cent in just one year. Councillor Cate McDonald, cabinet member for health and social care, wrote: “Budget pressures continue to make this a challenging time to deliver adult care and support in Sheffield. More people are requesting our services; and the cost of providing these services continues to rise. To continue to provide high quality services within the new lower budgets will mean that difficult decisions will have to be made.”

Although this report covers all social care it highlights a higher level of dissatisfaction in Sheffield from service users in comparison to the rest of Yorkshire and Humberside and nationally.

A local disabled man told Healthwatch Sheffield; “My carers are good but don’t always come at regular times so it’s hard to plan my day. This is typical. The morning carer came at 10 as planned. The teatime carer, who was due between 4 and 6, only came at 7. Half an hour later, the bedtime carer, who should come between 8 and 10, turned up. I wasn’t ready for bed and had only just had my tea. I told the carer not to bother and that I’d sleep in my wheelchair. I’m a grown man and should not have to go to bed at 7.30.”

“Good quality care at home is essential, not just for the person receiving it but also for their unpaid family carer,” said Celia Robinson, chief executive of Sheffield Carers Centre. “When somebody doesn’t receive the care they need when they need it, it’s nearly always a relative or friend who picks up the pieces at the bottom of the pile. That relative may already be exhausted from looking after their loved one and many unpaid carers are prevented from getting a break, going to work, seeing friends or looking after their own health if they can’t rely on the person they care for being looked after.”

A report by the King’s Fund into social care for older people noted that the funding situation is becoming critical. Many care providers now rely on people to fund their own care and those dependent on local authority funding face an uncertain future.

Although the situation seems bleak, we have heard many comments from people who find that home care really improves their quality of life. One older respondent said; “My carer is very friendly and helpful. She helps with my personal care, takes me out, then we have tea and chat. I really look forward to seeing her.”

Healthwatch Sheffield is working with voluntary organisations and the council to find out what people think about home care. The Healthwatch Sheffield Care at Home survey is available online at https://www.surveymonkey.co.uk/r/care-at-home until February 15.